Obsessive-Compulsive Disorder

There's a thin line between fitness and obsession.We were sipping wine when my best friend exclaimed, "I'm going to be a figure model!"

"Oh, cool!" I tried to mimic her enthusiasm, but honestly I had no idea what she was talking about. "Um, what's a figure model?"

"A competitive bodybuilder," she explained. It surprised me. My best friend, Amanda Anderson, was the tiniest person I knew and not because she didn't eat. When we were little, she'd routinely down a dozen pancakes for breakfast. She apparently just had a crazy high metabolism.

Maybe I shouldn't have been surprised; competitive bodybuilding takes an unnatural level of self-discipline and that's something my BFF possess for sure. In our early twenties, we'd dance all night at a club, then we'd take the 5 am train home, and I'd go to bed while she put in a full day at work. Maybe that commitment to raging prepped her for this intense sport.

And because of how intense it is, Amanda's life has now changed. She's more dedicated to the gym than ever. She works out for two to three hours a day during show prep and her eating habits have changed considerably. "The goal is to always be bigger, be better than last time," she tells me. And Amanda insists bodybuilding has boosted her wellness, saying she's healthier than she's ever have been, not only physically but also mentally.

For some people, the controlled stresses of bodybuilding make it an ideal form of fitness. Professional trainers and doctors agree that the practice can be beneficial if participants respect certain boundaries. But there are circles within the bodybuilding community that champion dangerous and extreme practices as "hardcore." These people repeat clichés like "no pain, no gain" as though it's scripture. And some individuals have unseen risk factors that can make bodybuilding a health hazard. There's a psychiatric condition lurking in the industry called muscle dysmorphia, which for some can be deadly.

"Bodybuilding is a sport anyone can do if they're willing to commit to the hard work," says Olympic class athlete and personal trainer Maik Wiedenbach. "Wanting to get bigger and better is normal in bodybuilding. You can do it and still be healthy." The problem is, "people with muscle dysmorphia think about nothing else. They'll do anything to get bigger and it ruins their lives."

Muscle dysmorphia (MD), popularly known as "bigorexia" or reverse anorexia, is an increasingly prevalent psychiatric disease. It's currently classified as a subtype of obsessive compulsive disorder, but some doctors feel it's more accurately described as an eating disorder.

Stuart Murray, clinical psychologist and co-director of the National Association for Males with Eating Disorders, explained that patients with MD often display "disordered eating, rigid rules of protein consumption, having to eat every X number of hours, having to eat X amount of grams of protein per body weight, and distress if one deviates from those. And we see pretty compulsive exercise practices usually oriented to the development of muscularity"—both gaining musculature and losing body fat to define it.

At a glance, those characteristics are eerily similar to the average habits of most competitive bodybuilders, but Murray emphasizes, "Bodybuilding in itself is not pathological. But there are a certain number who have the propensity and risk factors for muscle dysmorphia who gravitate toward bodybuilding." There hasn't been enough research to determine who's most at risk.

Healthy bodybuilding is possible if a person is capable of making the sport a priority without letting it impair their lives. Healthy athletes may desire to bulk up, and they might follow a rigorous training schedule and eating plan, but they can still acknowledge and celebrate their accomplishments. People suffering from MD, on the other hand, often display a misperception about their appearance. They don't see their own muscle mass; they believe they're small or undefined. They might even wear multiple layers of clothing to camouflage their body or avoid social situations. More than anything, they fear losing weight or getting smaller.

Wiedenbach, who's been training bodybuilders for a decade, attributes the tragic suicide of one his friends to MD. "He weighed 235 and wouldn't leave the house without pumping first. Eventually, he wouldn't leave the house at all because it burned calories. For people with this disorder, life becomes a cycle of working out, eating, sleeping and planning the next meal." Wiedenbach's attempts to help his friend were rebuffed and the compulsive behavior led to drug abuse, divorce, and lost friendships before his friend finally ended his own life.

This storyline is sadly common. Wiedenbach has watched numerous athletes slip into muscle dysmorphia. "Some turn to prostitution to pay for the lifestyle," he says. Muscle dysmorphia is expensive. The costs of training, food, traveling, and competing add up quickly, but when you tack on the costs of drugs, it becomes exorbitant. "There's a fetish industry willing to pay a lot of money to be with male and female bodybuilders. Some people pay just to touch their muscles." And people with muscle dysmorphia are willing to do whatever it takes to get bigger.

Unfortunately, trying to help someone with MD is often futile. People with MD tend to cluster around one another perpetuating each other's delusions. "In some circles, it's okay to sacrifice important parts of your life or separate from your spouse in pursuit of your musculature goal," Murray says. Wiedenbach describes a mob-like mentality among the most ill; a subculture where health is overlooked and dangerous practices are encouraged all in the name of getting bigger.

Murray agrees: "Oftentimes those with it don't perceive it as a psychiatric condition, often times it can even be seen as favorable," which means that very few will present or seek treatment. And because this disorder is so unknown, those that do seek treatment are often misdiagnosed, he says. MD affects predominantly men but can absolutely affect women. Research published in Comprehensive Psychiatry found MD occurred in 8.3 percent of competitive bodybuilders, while a South African study found that up to 53.6 percent of professional competitors exhibited symptoms of MD. The differences in these statistics is likely due to the small sample sizes; no large scale studies of muscle dysmorphia have been conducted.

In Wiedenbach's experience, people with MD often "get sick from drugs before getting help." Those that don't get help may turn to suicide and drug abuse. Murray notes that the nature of the disease puts those with MD at an increased risk for kidney and thyroid dysfunction.

On the rare occasion that the disorder is properly diagnosed and the individual is willing to seek help, it's often addressed with cognitive behavioral therapy, antidepressants, and anxiety medications. But it's important to note that there are no controlled studies examining treatments for MD. And whether or not competitors can continue to compete while receiving treatment is unknown. Wiedenbach admits that putting a person recovering from MD into a competition might be, "like putting an alcoholic in a liquor store."

Just as there are higher rates of anorexia nervosa among the physique-oriented ballet industry, there is clearly a disproportionate amount of MD within the competitive bodybuilding community. We don't know if the championing of an ideal body shape contributes to this dangerous disorder, or if at-risk individuals are particularly drawn to the sport, or both. Hopefully, with research and awareness, the industry can encourage healthier attitudes and goals as far as gains go.

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Obsessive-compulsive disorder (OCD) is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions).Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety. A person's level of OCD can be anywhere from mild to severe, but if severe and left untreated, it can destroy a person's capacity to function at work, at school or even to lead a comfortable existence in the home.

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